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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Formative Research Study to Understand the Impact of Generic Substitutes for Various Patient and Caregiver Populations
Agency IC Tracking Number:
CDER
IC Status:
Unchanged
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Sample Recruitment Media Advertisement Language
Appendix M Sample Recruitment Media Advertisement Language_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Youth Screener
Appendix N Adolescent Screener EpiPens_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Adult Screener
Appendix O Adult AutoInjector Screener_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Programmed pre-screener
Appendix P Programmed pre-screener_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Adult Consent Form
Appendix Q Adult Consent Form_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Youth Assent Form
Appendix R Youth Assent Form_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Parental Permission Form
Appendix S Parental Permission Form_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Moderator Guide
Appendix T Moderator Guide_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Recruitment Confirmation and Reminder E-mails
Appendix U Recruitment Confirmation and Reminder Emails_virtual revisions.docx
Yes
Yes
Fillable Fileable
Other-Advance Letter
Appendix V Advance Letter_virtual groups.docx
Yes
Yes
Fillable Fileable
Other-Mailed Instructions
Appendix W Mailed Instructions_virtual groups.docx
Yes
Yes
Fillable Fileable
Other-Workbook
Appendix X Focus Group Workbook__virtual revisions.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Consumer Health and Safety
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
32
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Requested
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
32
0
0
0
0
32
Annual IC Time Burden (Hours)
48
0
0
0
0
48
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
OMB Memo - Formative Research Study on Impact of Generic Substitutions
OMB Memo - Formative Research Study on Impact of Generic Substitutions.docx
03/31/2022
List of Appendices (original submission and resubmission to complete study)
FDA Generic List of Appendices for OMB 2.18.22.docx
03/31/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.